title: Dipstick proteinuria as a surrogate marker of long-term mortality after acute myocardial infarction.
abstract: BACKGROUND
  Proteinuria and reduced estimated glomerular filtration rate (eGFR) are associated with an increased risk of mortality from acute myocardial infarction (AMI). However, it is unknown whether there is a difference in prognostic value for all-cause mortality between proteinuria and eGFR during post-AMI.
  
  
  METHODS
  A consecutive series of 101 patients admitted with AMI who received angioplasty were enrolled. Dipstick proteinuria and eGFR were assessed on admission: (i) the patients were divided into 2 groups according to the presence of proteinuria (proteinuria, n=25), or not (negative, n=76), (ii) the patients were divided into 2 groups according to lower eGFR (GFR<60mL/min/1.73m(2), n=31) or higher (GFR>60mL/min/1.73m(2), n=70). Clinical characteristics and 3-year all-cause mortality estimated by Kaplan-Meier method were evaluated in each group. Additionally, a multivariate Cox proportional hazards model was applied to evaluate which factor was associated with all-cause mortality.
  
  
  RESULTS
  Mean follow-up period was 914 days. Higher brain natriuretic peptide (BNP) levels were shown in the proteinuria and lower eGFR groups, respectively (proteinuria, 301±324pg/mL; negative, 146±159pg/mL; p=0.02; lower eGFR, 294±305pg/mL; higher eGFR, 142±161pg/mL; p=0.02). Three-year all-cause mortality was higher in the proteinuria group than in the normal group (p<0.001) and in the lower eGFR group than in the higher group (p=0.006). In a Cox proportional hazards model, the presence of proteinuria [hazard ratio (95% confidence interval), 4.51 (1.07-18.96); p=0.04] was selected as one of the predictors for all-cause mortality.
  
  
  CONCLUSIONS
  Dipstick proteinuria and lower eGFR in the early phase of AMI follow-up were related to increased plasma BNP level during the sub-acute phase and long-term adverse outcome. Dipstick proteinuria may be a prognostic marker for long-term all-cause mortality.
authors.affiliation: Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan. Electronic address: hisa128@asahikawa-med.ac.jp.
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Ota
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Takeuchi
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sato
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hasebe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000175:diagnosis*; D011934:Reagent Strips; D012306:Risk; D013997:Time Factors
chemical_list: D015415:Biomarkers; D011934:Reagent Strips; D020097:Natriuretic Peptide, Brain
keywords: Dipstick proteinuria; Myocardial infarction, pathophysiology; Prognosis; Renal function